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			<h3>My Health Risk Factors:</h3>
			<h2>Check the boxes of anything that is true for you:</h2>
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					<span style="font-weight: bold; padding-left: 110px;">Age:</span><br/>
					<input type="checkbox" name="chkBxAge1" value="male45"/>I am a male 45 years or older<br/>
					<input type="checkbox" name="chkBxAge2" value="female55"/>I am a female 55 years or older<br/>
					<input type="checkbox" name="chkBxAge3" value="female"/>I am a female with <a href="premature-menopause.html" target="_blank" style="font-size: 15px;">premature menopause</a> without estrogen replacement therapy<br/>
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					<span style="font-weight: bold">Diagnosed Disease:</span> <br/>
					<input type="checkbox" name="chkBxDisease1" value="cardiovascular"/>I have a diagnosed <a href="cardiovascular-disease.html" target="_blank" style="font-size: 15px;">cardiovascular disease</a><br/>
					<input type="checkbox" name="chkBxDisease2" value="pulmonary"/>I have a diagnosed <a href="pulmonary-disease.html" target="_blank" style="font-size: 15px;">pulmonary disease</a><br/>
					<input type="checkbox" name="chkBxDisease3" value="metabolic"/>I have a diagnosed <a href="metabolic-disease.html" target="_blank" style="font-size: 15px;">metabolic disease</a><br/>
					<input type="checkbox" name="chkBxDisease4" value="diseaseNotKnow"/>I do not know if I have any of the above diseases<br/>
					<input type="checkbox" name="chkBxDisease5" value="diseaseNone"/>I have <span style="font-weight:bold">NONE</span> of the above diseases<br/>
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					<span style="font-weight: bold">Family History: <br/>Do you have a family member who has had a <a href="myocardial-infarction.html" target="_blank" style="font-size: 15px; font-weight: normal;">myocardial infarction</a>, coronary revascularization, or sudden death?</span> 				
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					<input type="checkbox" name="chkBxFamily1" value="before55"/>My father or other male first-degree relative (brother, son) has died before the age of <span style="font-weight:bold">55 years old</span><br/><span style="padding-left: 164px;">from one of the above causes</span><br/>
					<input type="checkbox" name="chkBxFamily2" value="before65"/>My mother or other female first-degree relative (sister, daughter) has died before the age of <span style="font-weight:bold">65 years old</span><br/><span style="padding-left: 164px;">from one of the above causes</span><br/>
					<input type="checkbox" name="chkBxFamily3" value="familyNotKnow"/>I do not know this information<br/>
					<input type="checkbox" name="chkBxFamily4" value="familyNoOne"/>No one in my family has died from any of these causes<br/>
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				<li>
					<span style="font-weight: bold">Hypertesion: <br/>Do you have  <a href="hypertension.html" target="_blank" style="font-size: 15px; font-weight: normal;">hypertension</a>? </span> 				
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				<li>
					<input type="checkbox" name="chkBxHypertension1" value="systolic"/><a href="#" style="font-size: 15px; font-weight: normal;">Systolic Blood Pressure:</a> 140 mmHg or greater on at least 2 separate occasions<br/>
					<input type="checkbox" name="chkBxHypertension2" value="diastolic"/><a href="#" style="font-size: 15px; font-weight: normal;">Diastolic Blood Pressure:</a> 90 mmHg or greater on at least 2 separate occasions<br/>
					<input type="checkbox" name="chkBxHypertension3" value="medicaiton"/>I am using an <a href="antihypertensive-medications.html" target="_blank" style="font-size: 15px; font-weight: normal;">antihypertensive medication</a><br/>
					<input type="checkbox" name="chkBxHypertension4" value="hypertensionNotKnow"/>I do not know this information<br/>
					<input type="checkbox" name="chkBxHypertension5" value="blood"/>My blood pressure is within the normal limits<br/>
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					<span style="font-weight: bold">Physical Activity Level: <br/>Do you live a sedentary lifestyle? </span> 				
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				<li>
					<input type="checkbox" name="chkBxPhysical1" value="notParticipatingPhysical"/>I am not participating in regular physical activity<br/>
					<input type="checkbox" name="chkBxPhysical2" value="notAccumulatingPhysical"/>I am not accumulating 30 minutes or more of moderate physical activity on most days of the week<br/>
					<input type="checkbox" name="chkBxPhysical3" value="AccumulatingPhysical"/>I am accumulating 30 minutes or more of moderate physical activity on most days of the week<br/>
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					<span style="font-weight: bold">Obesity: <br/>Are you at risk for becoming obese?  </span> 				
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				<li>
					<input type="checkbox" name="chkBxObesity1" value="bmi"/>My Body Mass Index (BMI) is 30 kg/m2 or more<br/>
					<input type="checkbox" name="chkBxObesity2" value="maleWaist"/><span style="font-weight:bold">Males:</span> My waist girth is greater than 40 inches (102 cm)<br/>
					<input type="checkbox" name="chkBxObesity3" value="femaleWaist"/><span style="font-weight:bold">Females:</span> My waist girth is greater than  35 inches (88 cm)<br/>
					<input type="checkbox" name="chkBxObesity4" value="obesityNotKnow"/>I do not know this information <br/>
					<input type="checkbox" name="chkBxObesity5" value="obesityNotFit"/>I do not fit in any of these categories<br/>
				</li>
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